Sacred Heart Cancer Diagnoses Drawing On Old Technique

A technique first used to diagnose cancer about 50 years ago hasgained new interest at Sacred Heart Hospital in the hands of associate pathologist Dr. Ronald D. Luff.

The technique, called fine needle aspiration, "is no more difficult than drawing a blood sample," said the assistant director of cytopathology.

It involves the extraction of a few cells from an abnormal mass through a skinny needle. The cells are put in a sterile solution, then on a slide and are diagnosed within 30 minutes.

Performed in a doctor's office or in a hospital X-ray department, fine needle aspiration (FNA) involves no surgery or overnight stay and little, if any, discomfort from the needle, according to Luff. When the test result is positive, physicians can confidently proceed with surgical, radiation or chemical cancer therapy.

"Its advantage is it's fast, reliable and much less expensive (than alternative surgical biopsies)," he said. "We charge $35 to read a diagnosis."

The disadvantage is FNA is not recommended for all suspected cancers because some tumor diagnoses require larger tissue samples. Also, negative test results are difficult to interpret since they may be the result of inaccurate sampling.

FNA is of considerable benefit, said Luff, for many patients with previous diagnoses of cancer.

For the woman who has had a mastectomy and develops a nodule on the lung, "Doctors could presume it's a recurrence and treat it accordingly. Or they could do an open lung biopsy (involving major surgery and a hospital stay). Or, now, they could use FNA and have an answer in 30 minutes," he said.

FNA greatly benefits some 25 percent of lung cancer patients who have "oat-cell" tumors, which are best not treated by surgery. Before the skinny needle procedure, surgeons had to do open lung biopsies, Luff said.

Also, for leukemia patients and patients with previous colon and prostate cancers, FNA can provide laboratory diagnoses without surgery.

Sacred Heart is the first hospital in the Lehigh Valley, Luff believes, to have a team ready to take and diagnose the cell sample, and to perform it on such a large scale.

"In the three years I'm here, we've gone from doing hardly any to 20 or more a month," Luff said. "At a recent tumor conference (at Sacred Heart), all five cases discussed were diagnosed exclusively by FNA."

Working with him is Dr. Jeffrey Blinder, radiologist, whom Luff credits with an uncanny skill for reaching deep-seated nodules despite obstacles of bone or other organs.

Blinder is aided by X-rays and CAT scans of the problem area, and instruments which set the precise angle for needle insertion. Yet at times he must curve to the 5-inch flexible needle and guide it to the abnormal mass.

Blinder said the technique is safe, based on national studies in which the needle has been inserted at random on laboratory animals. A possible complication, however, is when air gets between the lung and chest wall.

Positive test results for cancer are received in 70 to 80 percent of the tests performed and the team's diagnostic accuracy is 96 percent, said Luff, who studied the procedure for a year at Johns Hopkins University Medical School.

Luff could take the cell samples, but prefers to train other clinicians to do it. He said he's not interested in obtaining more patients, only in making diagnoses.

Other clinicians doing FNA at Sacred Heart include ear, nose and throat specialists, general surgeons, pulmonary specialists and thoracic surgeons.

FNA training also is part of the family practice residency training at Sacred Heart. Residents receive a certificate upon completion.